Revue médicale suisse
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Revue médicale suisse · Dec 2010
[Non invasive ventilation in the ICU for the neuromuscular patient: ethical issues].
Non-invasive mechanical ventilation in patients with chronic neuromuscular disorders is an effective tool for treating dyspnea or sleep disturbances often observed in such patients. So, NIV has to be considered as a palliative treatment and it must systematically be offered to these patients. Mechanical ventilation, non-invasive or invasive (via a trachesotomy) have to be considered systematically with patients and families at an earlier stages of these diseases in order to design a strategy in case of acute respiratory failure. In a second parent paper of this issue, we discuss the medico-legal implications of mechanical ventilation in neuromuscular failure, particularly the end-of-life aspects.
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Revue médicale suisse · Dec 2010
[Non invasive ventilation in the ICU for the neuromuscular patient: legal issues].
The legal frame in which chronic mechanical ventilation is placed in Switzerland and France is discussed in this article. Safety of the patients and responsibility of caregivers are considered. We also discuss the ethical and legal aspects of the end-of-life of these patients, particularly when they decide that mechanical ventilation must be interrupted because they do not more tolerate their poor quality of life, and when they deliberately decide to die.
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The process of health care delivery in Intensive Care Units (ICUs) is subject to significant workload fluctuations and unpredictable events. Medical and nursing staff, while relying on protocols, must adjust to these "out of the routine" disturbances by displaying initiative and innovation. ⋯ The assumption is that this resilience ability may be intentionally built by a specific work organization. The theoretical framework of "resilience engineering" described here could be a powerful tool in organizational designing suited to the ICUs.
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Revue médicale suisse · Dec 2010
Historical Article[Hunger strike and forced feeding: a historical look at medical practices].
Hunger strike is not a disease but a common situation in prisons. This article takes a historical look at medical practices in connection with the forced feeding of hunger strikers. ⋯ Depending on the context and the political situation in the country, the fate of these people, mostly political prisoners, is described as humiliating and abominable frequently ending in death or irreparable consequences. Particularly difficult for health professionals, this act raises clinical, ethical and legal questions and refers to the fundamental principles of medicine.